Providers have the right to appeal a claim denial or partial claims payment. All payments and/or denials are accompanied by a Provider Remittance Advice (PRA) or a rejection notice; these documents provide the specific explanation of the payment amount or specific reason for the payment denial.
- If you have questions regarding a denial or partial payment, please contact the WPS Call Center, Monday – Friday, 8:00 AM – 4:30 PM, at 1-800-223-6016.
- For claims denied due to an error related to the service authorization, please contact the Inclusa Community Resource Coordinator or Health & Wellness Coordinator assigned to the member associated with the claim.
- To file a formal claims appeal, submit the Inclusa Appeal Submission Form and the documentation listed below within sixty (60) calendar days of the initial WPS denial or partial payment:
- Copy of the original claim
- Copy of the WPS Provider Remittance Advice (PRA)
- Send to:
Provider Claims Appeals
1407 St Andrew St, Ste 100
La Crosse, WI 54603
- You have the right to appeal to the Department of Health Services (DHS) if Inclusa fails to respond to your appeal within forty-five (45) calendar days or if you are not satisfied with Inclusa’s response to the request for reconsideration.
- All appeals to DHS must be submitted in writing within sixty (60) calendar days of Inclusa’s final decision. DHS appeals should be sent to:
MCO Contract Administrator
Bureau of Long Term Support
1 West Wilson St, Room 518
PO Box 7851
Madison, WI 53707-7851
- If you need assistance with any of the above, you may contact the following: